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Provisions of the U.S. Constitution authorize Congress to make laws by passing an “Act” (e.g., National Defense Authorization Act for Fiscal Year 2008). When an act is passed by Congress and signed by the president, it becomes a federal law, which generally supersedes any state law (unless it specifies that a state law may apply). An act can be codified in a number of statutes. These statutes are classified and coded in the United States Code. Title 10 of the United States Code houses all statutes regarding the armed forces.

When an act relevant to TRICARE becomes law, the Department of Defense (DoD), through the TRICARE Management Activity (TMA), directs Humana Military Healthcare Services, Inc. (Humana Military) on how to administer that law. This direction comes through modifications to the Code of Federal Regulations (CFR). The TRICARE Operations Manual, TRICARE Reimbursement Manual, and TRICARE Policy Manual are updated continually to reflect changes in the CFR. Depending on the complexity of the law and federal funding, it can take a year or more before direction from DoD is given through TMA and Humana Military can begin administration of the new policy.

Balance billing applies only to services covered by TRICARE. TRICARE’s balance-billing limit also applies when other health insurance (OHI) is involved. Providers may not bill beneficiaries for administrative expenses, including collection fees, to collect TRICARE amounts.

In addition to the balance billing being covered under federal laws (above), we also have the "hold harmless policy" at our disposal for non-covered services. From: http://www.humana-mi...nsibilities.asp

It states: Hold Harmless PolicyA provider may not require payment from a TRICARE beneficiary for any excluded or excludable services the beneficiary received from the network provider (I.e., the beneficiary will be held harmless) except as follows:

If the beneficiary did not inform the provider that he or she was a TRICARE beneficiary, the provider may bill the beneficiary for services provided.

If the beneficiary was informed that the services were excluded or excludable and he or she agreed in advance to pay for the services, the provider may bill the beneficiary.